Tuesday, August 16, 2011

Signing Out

With the new work-hour rules for medical interns, the ICU is no longer a place where every 4 days an intern spends 30+ hours in the hospital. I'm glad for the rules. 12-18 hour days are bad enough. However, what it leads to is a lot of passing patients from one resident to another, which, in turn, leads to a general lack of ownership of a patient. It used to be that you admitted your patient to the ICU and for the next 20-30 hours, stabilized them and figured out what was wrong with them. You knew their history inside-out and knew how to manage them and what to look out for. Now, you may admit a patient, but 6 hours later, you've signed the patient out to the next intern. The sign-out is a five minute conversation relating the patients history, status and what to anticipate. The receiving intern know very little about the details of the patient and has to essentially start over. This leads to lots of information falling through the cracks. I recently got handed a patient that had been in the ICU for several days. He was stable enough to be transferred, which meant, I write out the discharge paperwork. Since I didn't know the patient, all of it is based on previous notes. I have to trust that those notes are completely accurate and thorough enough or something important about the patient could be missed. Unfortunately, many notes are neither completely accurate nor completely thorough.

It's a choice between having overtired residents who are prone to make mistakes or this. I'm not sure which is better.

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